Depression is a very common condition, which affects about 5% of people significantly at any one time. It affects mood and brain function, disrupting sleep, home life, work, and relationships.

Treatment may be approached in different ways, and sometimes more than one type of approach can be used at the same time.

Depression brings feelings of misery, tearfulness and sadness. There are many other symptoms which may be present, to varying degrees. These include:

• Tiredness all the time
• Loss of drive
• A sense of uselessness and helplessness
• Loss of appetite and weight
• Weight gain (through "comfort eating")
• Sleep disturbance
• Loss of interest in sex
• Memory problems
• Irritability, and aggression
• Suicidal ideas
• Loss of self worth

If you think you might be or know you are suffering from depression, you should see your doctor.

In depression there is a relative lack of some of the chemicals used in the working of the brain. These chemicals are known as neuro-transmitters.

Often depression follows stresses, such as deaths, marital/relationship breakdown, job loss, money worries, retirement, etc. Changes in the body's hormones, as after pregnancy, may also be a trigger. There is a connection with the weather in some people - Seasonal Affective Disorder (SAD) where the lower amount of sunlight in the Winter is said to contribute to the depression.

Many times there is no obvious external cause, and it is just one of those things that nature does.

If you or your family are worried about the possibility that you are depressed, it is wise to see your doctor. Your doctor will ask you to describe your feelings and symptoms, and probably ask some questions to highlight other possible symptoms. These questions may take the form of a questionnaire which allows the doctor to give a score to how you are feeling. This is not only useful at that consultation, but enables monitoring over time and also makes it easier for other professionals to understand how you were at that time.

Depending on your symptoms, your doctor may arrange blood tests to make sure you do not have anaemia, hormone or other chemical disturbance. There are no blood tests as such for depression.

There are many ways in which to deal with depression. The "Just pull yourself together" approach does not often work and, when the sufferer cannot do this, they feel even worse. Professional counselling can be helpful, as can psychotherapy and psychoanalysis, but these latter two are very time consuming and quite costly.

One of the treatments most readily available to your doctor is antidepressant medication. These may be looked upon as a chemical crutch, which will help you to carry on your daily life. Depression can otherwise make day to day decisions very difficult, that might otherwise be easy. You will probably be able to stay at work, although this must be a decision between you and your doctor, bearing in mind the nature of your occupation.

You will have to decide whether antidepressant medication is right for you, based on your own circumstances and the advice of your doctor, but they can dramatically improve the situation. They are not to be confused with some of the tranquillisers which were widely used in the past (such as diazepam/Valium), and work in a completely different way.

They are not addictive, as they work by allowing your body to make better use of its own depleted brain chemicals (neurotransmitters). No drug is without side effects, but the side effects of the modern antidepressants are much less than the original ones.

Antidepressants take a while (between two weeks and two months) to have their full effect. To begin with you may notice side effects, which usually lessen after a few days, so if you can, it is worth persevering with the treatment. You should eventually get the benefits of regular, daily use of your medication. Your doctor can advise you on the possible adverse effects of the drug you are to take.

There are a number of different types of antidepressant drug, and your doctor will try to select the one most suitable for your circumstances. Possibly the most likely type you will receive will be a tricyclic antidepressant (amitriptyline, imipramine, dosulepin or lofepramine) or a selective serotonin re-uptake inhibitor (SSRI, fluoxetine/Prozac, citalopram, sertraline), but be guided by your doctor, not what suited your friend or neighbour!

In the normal way of things most people do better staying on their antidepressant treatment for between three and six months. By that time, if you stop the medication, you will usually be back to normal.

It is usually better to step down the dose slowly before stopping, for example once down to the lowest strength tablet or capsule, to taking it on alternate days, then every third day. You should discuss this with your doctor, and if, after stopping the drug, you either get new symptoms or revert to being depressed, you should see your doctor again.

• Relaxation techniques, meditation, yoga, and self-hypnosis all offer similar benefits, and if you can find a teacher or a class where you can learn one of these it might benefit your physical as well as your mental health. There are also some good books and tapes on the subject.

• Regular exercise is good for the mind and the body.

• Eat a healthy diet, with plenty of fresh fruit and vegetables. This is good for mind and body.

• Consider slowing down your pace of living. A short holiday might help.

• Avoid the things we tend to turn to under stress, as these will probably only make things worse. (Alcohol, too much coffee or tea, tobacco, or illicit drugs)

• Try to keep your mind active, for example on a hobby, a book, or watching the TV, rather than dwelling on your feelings which will only make you feel worse.

• If you are feeling desperate, ring the AASRA, or at least share it with someone. A friend, relative, clergyman, counsellor or medical professional may not be able to solve everything at once, but sharing a problem helps, and the other person will probably be able to help you to find appropriate further support.

It is impossible to live without stress of any kind, but it may be that there is something about your lifestyle which, on reflection, could be changed to reduce the stress for you. Do not, however, make major life decisions while you are depressed. You could make a bad choice and regret it later.

Part of the problem with depression is not admitting to yourself, or others that you are suffering. What we British call "keeping a stiff upper lip" or "putting a brave face on it" is not always a good thing.

Certainly, once you have had a period of depression, you or your family or friends should be able to recognize the signs a bit earlier if it happens again. If that occurs, seek help from your doctor sooner, especially if you have found a treatment that works for you.

• Depression Alliance
• AASRA - Helping people in despair
• Medinfo: SSRIs, Selective Serotonin Reuptake Inhibitors

Books

Climbing Out of Depression, by Sue Atkinson

A short, practical guide on how to recover from depression.